Healthcare Provider Details

I. General information

NPI: 1134853849
Provider Name (Legal Business Name): THE PLAYFUL PLACE FOR ALL, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 07/11/2022
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 PLAIN ST
MARSHFIELD MA
02050-2731
US

IV. Provider business mailing address

424 AUTUMN AVE
DUXBURY MA
02332-4621
US

V. Phone/Fax

Practice location:
  • Phone: 508-789-9323
  • Fax:
Mailing address:
  • Phone: 508-789-9323
  • Fax: 781-319-2882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LAURA DESROSIERS
Title or Position: BCBA/ OWNER
Credential: BCBA, LABA
Phone: 508-789-9323